2025 CPT code 32659
Effective Date: N/A Surgery - Surgical Procedures on the Respiratory System Feed
Thoracoscopy, surgical; with creation of pericardial window or partial resection of pericardial sac for drainage
Modifiers may be applicable in certain situations, such as modifier -59 (Distinct Procedural Service) if the pericardial window is performed in conjunction with another distinct procedure during the same operative session.
Medical necessity for 32659 is established by the presence of a symptomatic pericardial effusion causing significant hemodynamic compromise or respiratory distress. The procedure is necessary to relieve the pressure on the heart and improve the patient's condition.Malignant effusions or effusions with suspected infection also necessitate intervention for diagnostic and therapeutic purposes.
The physician is responsible for the preoperative assessment, including imaging studies to determine the extent of fluid buildup. They perform the procedure under general anesthesia, create the pericardial window or perform the resection, manage any complications, and oversee postoperative care, including chest tube management if necessary.
In simple words: This procedure drains excess fluid from the sac around the heart by creating a small opening. This fluid buildup can put pressure on the heart and make it hard for it to work properly.The doctor uses a tiny camera and tools inserted through small cuts in the chest to create this opening, allowing the fluid to drain away. Sometimes a small tube is temporarily left in place to help with drainage.
This code describes a surgical thoracoscopy procedure to create a pericardial window or partially resect the pericardial sac for drainage.A pericardial window is a procedure that creates an opening in the pericardium (the sac surrounding the heart) to drain excess fluid. This fluid buildup, known as pericardial effusion, can compress the heart and impair its function. The procedure involves inserting a thoracoscope (a small camera) and surgical instruments through small incisions in the chest wall. The surgeon then creates a window in the pericardium or resects a portion of it, allowing the fluid to drain into the pleural cavity (the space surrounding the lungs) or be removed via a chest tube.
Example 1: A patient presents with shortness of breath, chest pain, and low blood pressure. Echocardiography reveals a large pericardial effusion causing cardiac tamponade. A VATS pericardial window is performed to drain the fluid and relieve the pressure on the heart. A biopsy of the pericardium is also taken to determine the cause of the effusion. , A patient with a history of lung cancer develops a malignant pericardial effusion. A VATS pericardial window is performed to drain the effusion and improve the patient's symptoms. Talc pleurodesis is performed concurrently to prevent recurrence of the effusion. , A patient undergoing anticoagulant therapy after heart valve replacement develops a pericardial effusion. A VATS pericardial window is performed to drain the fluid and prevent further complications.
Documentation should include operative report detailing the procedure (pericardial window creation or partial resection), the approach used (VATS), the amount and character of fluid drained, any biopsies taken, any concomitant procedures performed (e.g. talc pleurodesis), and postoperative management. Preoperative imaging studies (echocardiogram, CT scan) confirming the presence and extent of pericardial effusion, and documentation supporting medical necessity should also be included.
- Specialties:Thoracic Surgery, Cardiothoracic Surgery, Cardiac Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center